John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Narcolepsy is a chronic disease of the central nervous system. The symptoms include excessive daytime sleepiness (EDS), loss of muscle tone (cataplexy), distorted perceptions (hypnagogic hallucinations), inability to move or talk (sleep paralysis), disturbed nocturnal sleep, and automatic behavior.
Narcolepsy usually begins in teenagers or young adults and affects both sexes equally.
Abnormalities in the structure and function of a particular group of nerve cells in the brain called hypocretin neurons are thought to play a role in the development of narcolepsy.
The diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests (polysomnography and multiple sleep latency test).
Treatment options for narcolepsy include drug and behavioral modification therapies and disease-specific education of the patient and family members. The treatment should be individualized, depending on the types and severity of the symptoms, the life conditions of the patients, and the specific goals of therapy.
Optimal management usually takes weeks to months to achieve and requires continued communication among the physician, patient, family members, and others.
Alerting medications are used for the treatment of excessive daytime sleepiness. Amphetamines and methylphenidate (Ritalin) are general CNS stimulants that decrease sleepiness and improve alertness. Modafinil (Provigil) and armondafinil (Nuvigil) have alerting effects similar to those of the traditional stimulants but has less undesirable side effects.
Anticataplectic medications are used to treat cataplexy, hypnagogic hallucinations, and sleep paralysis. Tricyclic antidepressants (TCAs) are often effective in controlling cataplexy, but also frequently produce side effects that could limit their use.
Selective serotonin reuptake inhibitors (SSRIs) are also useful in the treatment of cataplexy and their side effects are milder. Sodium oxybate (Xyrem) is a medication with anticataplectic effects that also improves disturbed nocturnal sleep.
Behavioral approaches to treating narcolepsy include establishing a structured sleep-wake cycle and planned naps, and involve diet, exercise, and occupational, marriage, and family counseling.